Can the Coalition's copayment policy be repaired?

A deal on GP copayments will still compromise the structure of our health system, without any benefit for patients or the budget, writes Stephen Duckett.

The prospects for the Coalition's $7 original copayment plan are not looking good. Clive Palmer previously said Palmer United Party senators would join Labor and the Greens to block it in the Senate, though he has since indicated that he might be willing to compromise.

Health Minister Peter Dutton has also hinted that he is prepared to modify the proposal, and has spoken with Australian Medical Association president Brian Owler to see if there is a middle road.

But how could the plan be salvaged, and what would it mean for patients and the budget?

The Government's original proposal was to charge fees to all patients, for the first time in decades. No-one would be exempt. Pensioners, people who don't have a job, and all other concession card holders would have to pay a $7 fee for their first 10 GP visits and for pathology and x-rays.

Basically, the plan is to move from universal coverage to universal fees.

Any compromise would probably involve winding this back a bit. It might involve exempting pensioners, or lowering the new, mandatory fees. That might sound like a moderate, middle road. But it remains radical and misguided. While the government's proposals have not been passed, the budget has been a success in one regard. It has shaped the debate so it is about copayments going up - no one is talking about the people for whom copayments are already too high.

One reason the co-payment is having such a bad time politically is that it is seen as unfair. Although wealthy people pay more on out-of-pocket costs in absolute terms than poorer people, poorer households pay a much higher proportion of their income than wealthier households. Some poorer households pay very high proportions indeed. In one in 10 of the poorest households that pay out-of-pocket costs, those fees eat up more than 20 cents in every dollar of disposable income.

As a result of high out-of-pocket costs, families are missing out on health care. Many people already miss out on health care because of cost: 5 per cent skip GP visits, 8 per cent don't go to a specialist, 8 per cent don't fill their prescription and 18 per cent don't go to the dentist.

In addition to problems of fairness, the $7 policy is probably bad economics as well. The government's modelling however has been pretty crude: all that's been announced so far is that there will be about 1 per cent fewer visits, that's a drop of about a million visits.

But it's which visits are reduced that is crucial - if they are the wrong ones, health costs could go up instead of down. A GP visit costs government, as a conservative estimate, about $100, taking into account possible pathology tests or x-rays. If a person doesn't go to a GP and their condition deteriorates, they may end up in a hospital emergency department (which costs at least three times as much as a GP visit), being admitted to hospital (50 times the cost) or both.

If patients make the wrong judgment call about whether to see a GP just once in every 50 times about whether they should see a GP, and they end up in hospital, then any system savings have vanished. Other costs, such as additional days off work because of worsening conditions or hospital admissions make the economics look even sicker. On top of that, some modelling suggests that waiting times in hospital emergency departments will blow out because of increased demand shifted from GPs.

Despite putting patients at risk, new fees won't help the budget bottom line. Any revenue gained is squirreled away in the Medical Research Fund.

Even a watered-down co-payment increase would leave us with all these problems and risks. It would stop some people getting care they need, it could lead to higher health care costs, and it won't improve the budget situation.

Universal fees will also have a more insidious impact. They would be a fundamental change to Medicare, effectively abolishing bulk-billing. They would recast Medicare as a 'safety net'. That's not what Medicare is.

Medicare's predecessor, Medibank, replaced a mish-mash of schemes which were meant to be safety nets, but they didn't work. Many people had no coverage against the cost of health care at all. Medibank and Medicare fixed this mess and we joined the rest of the developed world (other than the United States) by implementing a universal health scheme.

This is now under threat. If Medicare is no longer for everyone, we will have torn up a big part of our social contract. Medicare has been very popular, probably because of its universality. People on Struggle Street, on variable incomes, know that they are covered whether they are marginally under or marginally above some magical cut-off.

A compromise deal on co-pays will compromise the structure of our health system. Since there is no benefit for patients or the budget, PUP senators and other crossbenchers should maintain their opposition to mandatory copayments and resist the end of Medicare as we know it.

Stephen Duckett is the director of the Health Program at Grattan Institute. View his full profile here.

Comments (292)

Realist:

13 Aug 2014 5:05:49pm

So people could make a wrong call on whether to visit the doctor or not? Of course people make the right call now every time without fail don't they. If this logic has any value then we should have mandatory doctor's visits for everyone at prescribed intervals, you know, just to prevent people making the wrong call.

And costs 'could' go up rather than down? Well let's try it then and see shall we? After all, they 'could' also go down or just stay the same.

This hysterical nonsense exposes what the opposition to the co-payment is all about. "The end to Medicare as we know it" is the cry. Well so what? The motor car meant the end of travel as people knew it, the internet meant the end of communication as we knew it and so it goes on.

An argument that says we need to stay in the past for the sake of it is no argument at all. Other medical systems use co-payments and those systems haven't collapsed why should ours?

crow:

13 Aug 2014 5:36:18pm

"The end to Medicare as we know it" is the cry. Well so what? "

well given universal healthcare has been one of the biggest positive inputs into Australian society and its standards of living in its history, Im a little more wary about tossing it onto the bonfire of neo-liberalism profiteering than yourself.

pink feather duster:

13 Aug 2014 11:43:33pm

Well done realist,

In the US college funds/trusts are started at birth for children by parents who can do it (and some that can barely do it). Parents, saving money in the order of 120k by the time the little ones turn 18. For each child they have. That's big money for parents, and the 'students' that get there usually aren't all that bright. Think Private school-esque types. Pyne is the federal education minister. I make no judgement. It is a current fact that Pyne is our country's 'education minister'.

Healthcare in the US can lose you your family's home if your insurance company refuses to pay out on a particular claim that they find a loophole to exploit loss free to the shareholders.

Welcome the newest litigation capital of the world. Australia.

Where the big end of town bankrolls your democratic electoral candidates. And your best democratic option is joining a 'class action'.

Good luck to you, in litigation lawyer wonderland, in the new Australia, and enjoy the new national democracy of 'ambulance chasers'.

hugh mungus:

13 Aug 2014 7:27:28pm

"The end to Medicare as we know it" is the cry. Well so what? "

Medicare has more support from the Australian public than the LNP will ever have, even in your wildest dreams. It also happnes to be the envy of most of the civilised world, because it produces better health outcomes at lower cost than most other schemes. Your loony mates Abbott and Hockey want to discard it in favour of a US style system where 20% of the population cannot afford medical care, and those who can afford it pay more for it than we do here.

stupendus:

14 Aug 2014 12:06:30pm

stop subsidising private health cover and more people will stop paying for it and put more pressure on the medicare system, that way everyone loses, by spending some money subsidising private health the government saves much much more in medicare costs

Jimmy Necktie:

John51:

14 Aug 2014 4:28:45pm

Stupendus, the biggest and fastest growing area of increase to the budget when it comes to health care is the subsidy of private health care. But that is only one part of the cost pressure of an expanding private health care sector.

The private health care sector with private hospitals competes with the public hospital sector for doctors, nurses, and other allied health professionals. This competition pushes up the cost of their wages and charges to the public sector and therefore to state budgets.

It is about the national cost of health care, public and private, to the budget and to the individual. The larger the private sector, the greater the cost increases. For a start the public hospital and health care system needs to demonstrate a difference with the public system. That means their costs are higher than the public system for the same procedure.

Smartest Person in the Room.:

13 Aug 2014 7:37:39pm

I tend to agree with realist about co-payments. The issue is at what level? There is nothing objectionable about a $7 fee for all. I would object to pensioners being exempt when they receive more than those on say Newstart. I'm fed up with self funded retirees who earn not much more than the pension missing out of every discount pensioners receive.

The problem is that in Australia we already pay the second most, after the US, in out of pocket expenses. It's the rest of the recommendations in the Commission of Audit report which the Coalition want to implement that is truly scary i.e. handing more over to private health insurance companies.

Susan:

14 Aug 2014 7:37:49am

So, for the poor old dears living in homes where they get a grand total of $15 a fortnight to spend on 'personal expenses' - do you think $7 is fair? How do they then pay for their medications? Smartest person in the room, I don't think so.

Septic the Sceptic:

14 Aug 2014 8:33:06am

Susan's "poor old dears" won't pay the co-payment, so that problem is solved.

What about the "old dears" that go to the Dr every day just to talk to someone. Every town seems to have one. If their car isn't parked in front of the surgery every morning, people start to get worried they might be sick.

Gary:

14 Aug 2014 11:16:59am

Septic's "old dears" probably won't be paying the surcharge either. So how will it solve his likely completely fictional problem.

There are surely far easier and simpler ways to solve the occasional overservicing problem than by slapping every single person with a surcharge - which most research suggests will actually increase overall healthcare costs.

Stuffed Olive:

Jimmy Necktie:

14 Aug 2014 7:56:36am

"There is nothing objectionable about a $7 fee for all"

I pay $100 per visit then I'm rebated $62, meaning I already "co-pay" $38 per visit. So rather than just adjust the rebate to $55 which would make sense since it uses an existing architecture, they introduce a separate charge to be administered and tracked.

For goodness sake, the whole thing should be covered by taxes, with no rebates, no co-payments, no difference at all from one GP to the next. One simple system for everyone.

Peter the Lawyer:

14 Aug 2014 10:48:10am

Jimmy

I thought that the $7 co-payment was only going to apply where the Doctor bulk-billed. For the rest of us who pay the doctor full freight and then get reimbursed something from Medicare will not be affected by the co-payment, because that is what we do already.

Sir Trent Toogood:

Lucky:

Stuffed Olive:

14 Aug 2014 2:24:55pm

I think it applies to all and the rebate is going down. Either way, it hasn't been explained properly. I'm totally against it and the stupid Medical Research Fund. They've slashed medical related matters elsewhere to the tune of $7 Billion to plonk into the fund. It's rotten and unsupportable. Combine that with their plans to flog off Medibank and outsource Medicare refunding it all stinks. Hand over government business to big private business to run and make money from. Bonkers. Save money? No way.

John51:

14 Aug 2014 4:36:00pm

Olive, if the medical Research Institute was going to fully pay its own way as they claim from its research than the government could set it up through the use of government bonds. The research would eventually pay back the bonds and interest. That is if it was to be as successful as they claim.

Just a thought. There are always other options to the lousy one that they have put up. I wonder whose thought bubble it was.

Jimmy Necktie:

DannyS:

14 Aug 2014 6:28:30pm

Jimmy, here's a bit of a rundown.......

GP visits have item numbers that they ascribe to your visit.

Item no. 3 is for visits where the GP knows why you are coming in. You've been there before for whatever condition you have and just needs to follow up on your progress for example. Medicare rebate $16.95.

Item no. 23 is for when you visit a GP and they ask you what's wrong, you tell them, they hopefully remember their university days and tell you what they think would be the best thing to do about it. Takes maybe 15 minutes. Medicare rebate $37.05.

There would appear to be very, very few GP's in Australia that charge you for an item 3. Need a prescription renewed? No worries, takes 2 minutes to ask how you're doing, but no worries, charge you for an item 23.

Item no. 36 is for when a patient presents with more than one condition and the GP has to assess these conditions and recommend possible multiple strategies. Medicare rebate $71.70.

floss:

14 Aug 2014 1:40:49am

Perhaps an end to medicare as we know it would be a good thing. Rather than having a reactive model we should have a proactive model.

If, as Realist suggests, everyone does have a regular health check, say yearly, then conditions like obesity would be picked up before secondary conditions such as diabetes, heart disease and cancer developed.

Mind you, this would pull all the people into the system who currently rarely see a doctor; there are probably more of them than those who consult a doctor when they do not really need to.

There! Now that I have saved the health system millions of dollars, we no longer need a medicare co-payment.

Noah's Ark:

13 Aug 2014 5:44:32pm

That's why the majority of the Western European nations, Scandinavia and Canada all have universal health systems. Even in the UK with the disasterous Cameron austerity measures they will not touch the National Health system. Canada has a Neo Conservative government but does not touch its universal health system. Probably because Canada has seen what happens just over the border and where United States citizens go up to Canada and pose as Canadian citizens to access medicines and doctors. Some Yanks just die at home or on the streets thanks to their wonderful private health care system. But even in the United States Obama is trying his hardest (although up against powerful evil interests) to introduce some form of universal health care. Beware United States citizens the Reds are back under beds mantra by the Neo Conservative nut jobs.

But yeah we in Abbott land must of course follow the worst of American outcomes on health care and privatise our health system and subcontract it out for profit. We already know what will happen if we continue down this hopeless path. A privatised health system that would be two tiered at best thereby forcing even doctors with a social conscience and social contract to appease the private health care system and in the process create a strata of highly paid medical professionals who are more concerned with how much money they can screw out of the system than actually doing the right thing by society and caring for the maimed and sick and elderly.

Hockey just because you have had a good run in life (a lot of luck and fortuitous outcomes dressed up as hard work) does not give you the right to impose an unjust system on middle Australia and the poor and wreck what is a good universal health care model just because of your insatiable desire to punish those who are not so fortunate through incoherent babble about the bottom line , profit at the expense of society and the Budget Emergency that you are doing your best to impose on the rest of us as a pretext for Neo Conservative / Neo Fascist ideology.

ig:

13 Aug 2014 5:45:37pm

As a GP let me tell you I spend most of my day reassuring the worried well. What is worse is now days patient demading expensive investigation when nothing is wrong. What to really see the problem with the health system for every 100 investigations only 1 abnormality ( across all doctors) tell these patients nothing is wrong and just wait for the complaint.

ig:

13 Aug 2014 7:18:36pm

Want a bet ! let him show you his results from just one day of patients. Less than one in 50 will have a abnormality. Ask him if he is a bad doctor or he did the tests just to cover his butt and stop the whinging well.

Noah's Ark:

13 Aug 2014 8:39:21pm

ig You are nothing like my GP. My partner goes to a bulk bill GP practice which is open from 7.00 am to 9.00pm Mon to Fri and open 8.00am to 6.00 pm Saturday and 9.00am to 6.00 am on Sunday. There are always queues and a waiting time of several hours is not uncommon.

I can tell you my partner and others DO NOT go to the doctor over minor issues or just random "I am worried about nothing scenarios". Even the low socio economic don't like to wait around for ostensibly wasting the GP's good efforts as you have described.

I myself only go to my GP for good reason and that does not include the common cold or Flu. So therefore as a GP I just don't believe you.

If the AMA came out and issued a blanket statement backing up you so termed assertions maybe there could be some substance in that. But someone posting on the internet with your insinuations. No way .

Sir Trent Toogood:

Darren:

13 Aug 2014 9:41:03pm

Ig. Just because a GP says nothing is wrong doesn't mean there is nothing wrong. I have NEVER known a GP to enquire about the effectiveness of the treatment they prescribe. My experience with GP's is that they are no better than drug dealers and dole bludgers, afterall GP's deal drugs and drain the public purse for the non treatments they provide. GP's should be embarrassed by how little they know after all the years they spend in university. Instead we get a bunch of overpaid know it alls who have no interest in the outcomes of the treatments they prescibe. Just because a patient does not return to you does not mean you were of any help to them. Your attitude stinks and it sickens me to know just how little help you are to GENUINELY ill people while you arrogantly pretend to know there is nothing wrong with them. Do you even know what effect nerves compressed by the spine have on the muscles they control? I do. I also know how to treat the muscles affected by the irritated nerve and its NOT with drugs. I had no choice but to live in pain for years until my own research delivered me the correct treatment despite countless visits to GP's without one of them offering the simple and inexpensive solution. All I was offered was drugs that did nothing to help me but my visit helped the GP and his bank account. Your post only confirms to me the stinking attitude I have long attributed to GP's who don't know half as much as they think they do. Wake up and take an interest in your patients wellbeing instead of reaching for the medicare invoice before you have done anything useful.

Chris L:

14 Aug 2014 8:24:51am

Go easy Darren. While I have met some unlikeable GPs in my life (not many), the truth is they all do an admirable and necessary job. The system is set up like a production line where they have to work through a long queue of people and, in many cases, make a best guess as to what their problem is (medicine is not the all-knowing force we like to think it is) so it's certainly not an easy job.

I don't doubt Ig's assertion that a lot of people probably show up to the clinic without anything serious (that they case diagnose at the time), but there are two truisms to support such action. "It's better to be safe than sorry", and "an ounce of prevention is worth a pound of cure".

As the article describes, the co-payment may act as just one more discouragement to seeking help and could therefore lead to easily manageable conditions being left to become a lot less manageable. Not a good idea.

Sea Monster :

13 Aug 2014 9:52:23pm

The picture you're painting is odd. You say a GP will see 50 patients a day all seeking 'abnormalities'. Are you on the level here, ig? As far as I can see people present with symptoms and the doctor decides whether to order tests or not.

I wish you'd defined abnormality better. It's not a very precise or (dare I say) scientific term. For example we expect a majority of tests to come back 'normal' but we still gain benefit by doing them. Pap smears for example (although it seems the intervals have been too close). Also STI testing. We want to control the spread. We need to test. We expect most tests to come back negative.

As a doctor would you recommend only symptomatic patients get gonorrhea, Chlamydia and syphilis tests?

Frankly, id, it amazes me that a doctor isn't across these concepts. Last year I had a battery of tests. Shoulder pain and a lump. Ultrasound.

Had a migraine that looked a lot like a stroke. CT scan. No abnormalities. MRI. No abnormalities. Doppler chartoid ultrasound. No abnormalities. Echo cardiogram. No abnormalities. Bloods. No abnormalities.

So there's six test. Zero % abnormalities. Are you saying I shouldn't have had them? Or perhaps I was a bit selfish going the doctor when my face sagged, I was temporarily blind and I couldn't walk or talk properly?

Also shouldn't you ethically look for a new job. How do you live with yourself when you take 98% of your income (subsidized by the taxpayer or not) for doing nothing. Is it fair to blame the suckers and not the charlatans?

rusty cairns:

14 Aug 2014 6:01:35am

GDay Dr igSo your saying 49 of 50 patients have nothing wrong with them and you can tell this by not doing any tests ?Mr fathers doctor told him to tell me to get regular tests for diabetes once I had reached the age of 50 years.Now at 58 years and not had a test for 2 years if I came to you would you reassure me well or take blood and urine for testing or with a referral send me to a place where this happens ?If the test came back negative would I be included in one of those 49 you mention ?How often do you suggest people have medical check ups ?Is health anxiety a mental illness ?Is the most effective treatment for hypochondria removing money from the sufferers pockets ?

Erika:

14 Aug 2014 12:58:58pm

So, until the Ross River Fever virus was identified and a test developed for it (early 90s, if I remember correctly), there was nothing wrong with the patients who had Ross River Fever but didn't show any abnormalities in their tests?

olive:

13 Aug 2014 6:44:14pm

Ig, GPs and other doctors are paying huge insurances. Why is this the case? I assume because they have a good chance of missing something or misdiagnosing. Doctors' over-confidence can lead them to end up being sued. Better safe (for both patient and doctor) then sorry.

ig:

13 Aug 2014 7:21:41pm

yep even with all the unnecessary tests we will still miss things. Just a fact of life. But we could order one tenth the tests and still miss about the same amount. ( just a few more) but the taxpayer has to pick up the huge cost

rusty cairns:

Dame Sark:

13 Aug 2014 9:36:52pm

And what about when you charge to extended consultations that take 10 mins - do you adjust the amount or still claim the same?Explain to me why a specialist charges $250 for an extended consultation and says it will take an hour (times 2 for twins, therefore we expected to be in his office for 2 hours) then takes exactly 35 minutes? He took $500 for 35 mins work. And you have the cheek to take about taxpayers picking up the cost, what about you doctors that are clearly costing taxpayers heaps?

Matt:

14 Aug 2014 2:26:23pm

@ Dame Sark

This has always annoyed me, I get to the doctors 5-10 minutes before my appointment I sit there for anywhere between 25 minutes to an hour, I finally get to see the doctor and I'm in there for less than 2 minutes and get charged $80 for a script.

Nell:

13 Aug 2014 6:47:09pm

As Terry Barnes, former health advisor to the Tories, said on the Drum tonight, the Australian Medical Association is the peak body for what is arguably the biggest union in the country. Barnes argued that it is doctor's self-interest informing their/your support for the co-payment, particularly in relation to preserving the rebate.

Barnes recommended a co-payment for attendance at a GP of $6. Instead the government came up with $7 for not just GP attendance but then also the radiologist, pathologist and so on which would result in what Barnes described as a "cascade" effect particularly and unfairly deleterious to the poor and disadvantaged.

As to the tedious business of reassuring the worried well perhaps instead of setting up fiscal punishment the government and the medical profession could counter some of the corporate and other entities that benefit by scaremongering the population, that profiteer from deliberate misinformation (most recently the crackpot assertions of Eric Abetz, the Endeavour Forum and possibly the Minister for Human Services and Medical Practioner Kevin Andrews. Have not yet heard whether he endorses the wild suggestion of the extreme right-wing that breast cancer is a punishment for terminations (never mind spontaneous naturally occurring abortions).

Where would the worried well go for reassurance - to bored, disinterested people like you. Have experienced this, doctor's who get you to sign the chit before the consultation even begins.

JessC:

13 Aug 2014 6:59:14pm

"What is worse is now days patient demading expensive investigation when nothing is wrong"

Really? It's the reverse with my GP, which is why I tend to use Dr Google these days (and spare myself the worry and expense of being referred to a specialist and having a myriad of invasive tests done that I really don't need).

And what about all those exhortations to get the flu vaccine - or die! - and all of the other check-ups that are supposed to pick up diseases early (when most of us would be better off not knowing about them).

rusty cairns:

14 Aug 2014 6:44:32am

GDay OaktreeI think there must have been a medical break though ?It seems the treatment for people with the mental illness of hypochondria requires money to be removed from the pockets of every person who see's a GP ?

adam:

13 Aug 2014 10:29:28pm

If that's true then it's just another indication of how misguided and dumb this co-payment policy really is. With a little intelligent application perhaps we could lower costs, work for more efficient diagnosis, even develop better management of patients who don't really need medical attention. That all seems to hard for the government so they've gone in with the blunt instrument of a fixed fee. The results will be unpredictable, uncontrolled and quite possibly counterproductive. I don't think it's good enough and that's why I object to it. You don't even have to break out the "it's unfair on the poor" argument.

Monty B:

14 Aug 2014 8:43:40am

ig: So we should pay a co-payment because you give in to pressure from patients with no medical training and perform expensive unnecessary procedures? Get a spine (backbone) and think of the patient and the taxpayer.

Gary:

13 Aug 2014 5:51:38pm

All of the international evidence suggests that overall health costs will increase.

But of course the government modelling only went so far as to model the cost of the doctor visits - not the overall health costs. Probably because the extra hospital costs will fall on the states - it is just another attempt at cost-shifting.

It is not hysterical nonsense to point out the facts. If you want hysterical nonsense try Ltd News' screaming headlines.

rusty cairns:

14 Aug 2014 7:10:29am

GDay Gary It beats me why the same people whom argued and voted to overturn the Northern Territory legislation which allowed the terminally ill the right to euthanasia to end their pain and the distress of their families and the burden of their healthcare costs, now want every one to pay extra to see a GP to stop people from seeing a GP unnecessarily and being a burden to the cost of healthcare ?

ScottBE:

Your argument that it is merely "the end of Medicare as we know it" just demonstrates how little you are aware of the arguments surrounding this terrible proposal.

It is very likely that health costs overall will increase as a consequence. People with chronic medical conditions need to have regular reviews in order to monitor for complications and worsening conditions. Certainly neither patients nor doctors want unnecessary appointments, but missing reviews will no doubt lead to unexpected complications which will result in Emergency Department visits and likely admissions..

Rhonda:

13 Aug 2014 6:21:36pm

Realist, there's a big difference between methods of travel and communication and outcomes for people's health. The catch-cry of the government was 'budget emergency', thus their need to impose harsh measures.

The problem is, the co-payment they are trying to inflict will not even be going to fund Medicare as one would expect, but it's going into research for the future (or so they say). To many less affluent, $7 extra is a big deal, as it may also require a $7 payment for pathology or medical imaging, tacked on to that GP visit.

The hollow claim that the LNP makes - that Labor willingly introduced a 'co-payment' with the PBS, is false. This is not a co-payment to see a pharmacist, it is a discounted price for (certain) scripted medicines, which normally would cost a whole lot more otherwise.

splod1:

13 Aug 2014 6:40:04pm

Realist: It is very easy to be blase about change if it's not going to inconvenience you very much. As the article(and many more before it) points out, the percentage of disposable income that the co-payment will cost the disadvantaged is far higher than it will be for the financially secure. Are you arguing from a position of such security?

JohnnoH:

13 Aug 2014 10:07:03pm

Dear Realist, why should we "give it a try and let's see"? That sounds like a hit and miss attitude which is ridiculous, but then again that would be in line with these fools who are in government. Why stuff round with something that is working, unless you want drop to American standard and that's below third world.

struck dumb:

14 Aug 2014 12:56:25am

Its going to be the sick who will put off visits to the doctor, that could well see them in a hospital bed. Its not rocket science to see that someone who could have prevented a heart attack, stroke or cancer treatment by going to the doctor instead of putting it off because they don't have the spare $7 for the doctor, plus $7 for the blood tests and another $7 for the x-rays in the same pay period is going to cost a lot more than a $100 visit to the doctor plus whatever the blood tests and the x-rays cost when they require surgery and a hospital stay. $21 may not be much out of your pay, but its a lot to the sick and elderly who also have medication to pay, and many often go without if their bills are more than budgeted for.People who live below the poverty line are not criminals, but we would get better treatment in jail. We don't live that way through choice either, most of us are there for circumstances beyond our control and many of us do not have superannuation to fall back on because it didn't exist when we were in the workforce. But we did pay taxes. Some of us do voluntary work and have done so for many years. And some of us are returned servicemen who were not career defence force. In short we are ordinary people doing it tough. You can go without a latte or two, but most of us do not visit places that sell them - we cannot afford to, even for a special treat! So when we have to pay a bunch of $7 co-payments in a short space of time, we will think twice before going to the doctor, and go to hospital instead and perhaps even take up a bed in intensive care. I think even you would understand that is not the better option.

Susan:

14 Aug 2014 7:35:42am

Realist, your name is not accurate. You clearly don't live in the real world, nor have you had any real life experiences. I pay a hefty medicare levy, but go to a private practice that does not bulk bill. Therefore, on the face of it, the $7 co-payment would not affect me. However, that is wrong. If I need any testing - instead of the radiology or whatever bulk billing medicare, I will now have to come up with the $1,000 for the testing, then claim back SOME of it on Medicare, leaving me with a hefty gap. Ok, I could do that if I needed to - does the fact that the poorer members of our society could not afford that affect me? Or you? I have to ask what am I paying a socialist levy for, if it is not assisting those that it should. If the less well off do not benefit from my taxes, I would rather not pay them. Ok, so it does affect me. I am paying for something I am not getting - a universal health care system. Now, what if I have an accident out of my clinic's operating hours, so take myself off to my local hospital? I would rather not sit in pain in the waiting room, while the triage nurses attend to a toddler with a boo-boo. It does happen, I have witnessed it myself. Everyone attending casualty is "assessed" and children earn more "points" and thus are moved up the queue. Too bad if the local superclinic is closed the night after all the tots have had their immunisations, because I will have to sit in the waiting room until dawn while all the little dears with the sniffles are bumped up the queue in front of me. And once again from a cost/benefit perspective - it costs over $290 for each attendance in hospital, compared to about $30-40 for a GP visit. So how are my taxes being spent wisely? How is this policy going to bring us back into the black - short answer is that it won't. People will suffer, and the money will be wasted on rubbish (lining the pockets of the rich with the lucrative r&d bonuses Hockey wants to hand out). Joe Hockey clearly knows nothing about anything (witness his most recent statements about how poor people don't have cars!) and I would rather not have him in charge of my tax $ as he clearly does not have a clue what he is talking about, and therefore I do not have any faith that ANY of his policies are valid. I have to wonder if he really believes the fairy floss stories he is spinning, is he really that stupid, or does he just think that we are?

John51:

14 Aug 2014 5:26:48pm

Realist, you fail to understand the most basic tenant of cost effective health care. And that is preventive and early intervention. Seeing your GP is both of those.

We know in medical health care research that there is an existing problem with men going to see a doctor for regular health care check ups. If you catch a health problem at the early stage than it is far more cost effective to treat it than at a later stage. And who knows it may even save your life.

Sorry, I had to laugh when your said "after all, they (costs) also could go down or just stay the same. You are talking about the health care system. And you forget that going to a doctor is only one part of the health care system and it is the cheapest part of the health care system.

If you don't catch something early enough than you can end up in the really costly part of the health care system, the 'hospital'. But than maybe that is the why the federal government is only concerned about the cost of medicare. Medicare comes under their budget costs where Hospitals come under the states budget costs.

But than if we had a half decent government they would be looking at how to contain if not reduce the whole of the national cost of health care. That includes not only Medicare, it contains the government subsidy of private health care, state budgets for the Public Hospital system as well as the private hospital health care system.

It is only when you look at the whole of the national health system costs, public and private that you can best understand how to contain costs. Did this government do that? No! Because if it had it would have better understood the benefit of seeing a doctor in containing costs. It would have better understood the place of preventive and early intervention in containing costs.

bobtonnor:

13 Aug 2014 5:23:08pm

that really is a rather silly statement isnt it, the 'social contract', if there is one, is a contract with society by its nature, and society by its nature is made up by people, therefore if 'everyone' disagrees with the copayment then part of the 'social contract' has been breached/torn up. Back to law school for you Ben.

hugh mungus:

13 Aug 2014 7:31:02pm

Only if you are a member of society. But neo-Thatcherites like you deny the existence of society, so you can't be a member. Hence your argument is invalid. Also, science has proved that lawyers (even pretend ones like you) aren't human so that counts you out twice. We humans look forward to not seeing you post here again.

aussieinjapan:

Thought the Australian public voted the current situation in. What we have is not one person that is deciding what is right but a collective agreement by the majority that what we have is right.

To often the argument seems to be (especially by those who have assets) the more taxes the more valuable your vote is. Hockey and his mates certainly think so as their policies by anyones measure favour the wealthy or should I say the very wealthy at the expense of the lower income earner.

Very similar to what is happening in Japan with perpetual falls in real incomes while big business is having its' tax rates cut even though there has been so much hollowing out of business.

Ben the lawyer:

Alpo:

13 Aug 2014 6:06:25pm

Ben, you can have a "social contract" on any issue. This doesn't mean that the concept of "social contract" is meaningless. Just take the word "social" away and just focus on the word "contract", you will see what I mean.

Alpo:

13 Aug 2014 7:13:05pm

C'mon Ben, you know that in any society there are contracts enshrined in law, others are part of the cultural baggage that, in fact, do affect politics and eventually the kind of laws that are accepted by the People. These are unwritten contracts. Do we have a written contract of the "fair go", for instance? No, we don't. Do we expect our politicians to consider the unwritten contract of the "fair go" when they legislate? Yes we do! How do I know? Just look at the popular reaction against the Budget from Hell (not just the $7 co-payment) to understand what I mean.

Noah's Ark:

13 Aug 2014 8:49:54pm

Ben .

The "social contract" is implied on society. Everything does not need to be black letter law. We in the majority of society are the ones who benefit from the "social contract" as in this case "Universal Health Care". That much is obvious.

To stand on legal interpretations as defence as it has not legally been written into and signed as a contract. Really . Stop wasting sensible people's time.

pink feather duster:

"I am puzzled, Ben. What would you exclude from the concept of "social contract"?"

Ben the lawyer,

"That's my point. If it includes everything, then it actually means nothing."

As for me and my input,

you are avoiding the question Ben, what would you exclude from it?

Jumping strait to it includes everything therefore it means nothing is a child like cop out in my opinion. And a classic avoidance and distraction of a strait forward question, quite clearly not answered, but deflected, to not much of reason, or tangible substance.

Ben the lawyer:

ScottBE:

13 Aug 2014 6:24:25pm

You don't seem to understand the concept of social contract Ben. It is the responsibility of a government to ensure there is adequate provision of health, education and welfare services. These are the basic stuff of life apart from food and water.

This government, like you, don't seem to understand the concept of responsibility.

Nell:

13 Aug 2014 7:45:36pm

Joe Hockey's remarks regarding the equitibility of the budget's fuel excise measure has him more or less saying the government doesn't want any responsibility for the poor and disadvantaged. Does not want the responsibility, does not want to empathise, does not want to care.

There is no point to those apologising for Hockey or blaming the media for "mishearing" (Abetz's duck and weave).

There is no point in trying to point out to Joe Hockey that there is a hierarchy of human needs. That his budget impacts on those struggling already with meeting the needs of food and shelter whereas impacts on people who are no longer concerned with just the basics of existence are different. They are able to better absorb the vagaries of any government's changeable policies.

When you add up the cascade effect of increases in fuel cost, increases in medical costs, significant increases in utility costs and the fact that Treasury already had data that showed that the value of pensions and benefits were not keeping pace with the CPI before this government was elected, then the outcome looks bleak.

We hear him loud and clear and there is no point in him wondering why he is not popular.

Edward:

14 Aug 2014 7:58:51am

Nell, I think Mr Hokey's coments on the fuel excise says more about his lack of understanding of his portfolio. Anyone with a modicum of common sense would know that a fuel price rise will filter through the economy, even to those that don't drive. How does he think that certain goods and service make it across this great land of ours? Oh, it's magic my carrots just appear on the shelf... no fuel used here.

Mr Hockey's comments simply highlight the fact that he is not qualified to be Treasurer and should be fired. Mr Abbott would do well to return to Australia and focus on some non poll driven issues rather than flying all the way to England just so that he can make a phone call to the UK PM.

Freddie Frog:

13 Aug 2014 8:05:39pm

Scott,I'd suggest it's the definition of "adequate" services and who exactly has access to them " for free" is what some people would disagree with you on.

And I'd suggest it's exactly the concept of responsibility that we are discussing. Some people believe in displaying a personal version of it rather than expecting the state to provide for them from cot to coffin.

Chris L:

14 Aug 2014 9:22:06am

It's easier to exercise the kind of personal responsibility you're talking about when life has been kind to you. Many people, through no fault of their own, are left without the resources to cover for events such as unexpected illness.

We all benefit from being a part of society, some more than others. I see it as no great hardship for the rest of us to help lift up those who have benefitted less.

Chris L:

14 Aug 2014 11:02:31am

I wouldn't expect such people to be very common Freddie. After all, there is pride to be had in self sufficiency.

Of course there are people who will just freeload as much as they can (and not all of them are low income) but I'd be very wary of punishing/neglecting everyone just to ensure the few undeserving don't get away with it.

Caffettierra Moka:

13 Aug 2014 11:22:32pm

The 'Strawman Argument'. Take your opponent's reasonable statement 'health care is something the state should provide' and dress it up as a ridiculous statement 'the state should give me everything I want whenever I want it and to hell with the cost!'. I think they have that on p. 3 of 'Law for Dummies'.

gerard oosterman:

13 Aug 2014 5:13:16pm

No. It cannot be repaired.Raise tax on the bloated and rich not on the emaciated and poor. What a Government, what a blight!Is it true that people are flighting to caves and mountain tops now, escaping metadata and strange retentions imposed by this government?

splod1:

13 Aug 2014 6:47:30pm

glen: You appear to assume that anyone who is "inconvenienced" by the co-payment is lazy and uneducated and deserves any problems it causes. I see: so, if you're poor, unemployed, chronically ill or a pensioner, then you've obviously frittered away your life and have only yourself to blame if you struggle to afford a "modest" co-payment for your health care. I hope that I have misread your post: if so, I apologise.

Chris L:

rusty cairns:

14 Aug 2014 5:19:43pm

GDay AE Does the mention of a certain PM's daughter and scholarship support your argument ?To many licenced drivers disobey the road rules.Would making all licenced drivers pay more because of this fix the problem ?

Waterloo Sunset 2016:

rod:

13 Aug 2014 11:54:33pm

Glen,

the judgemental always begin with an assumption that they are so much better than everyone else simply because they put a few poncy letters after their name, simply because they are all right jack, simply because .....

Two new concepts for you: (1) empathy and (2) try looking outside your own back yard and circumstances.

Terry2:

13 Aug 2014 5:16:11pm

What this government and this Minister need to do is explain clearly what is the purpose of the co-payment.

Is it to "send a signal" which will discourage some people from overusing our health system, then let's see the data on overuse and why it is that GP's are unable to manage this overuse - or are they partially at fault ?

If Medicare is genuinely unsustainable then what about a 0.5% increase in the Medicare Levy: again, let's see the data so that we can judge for ourselves.

If it is really all about creating a medical research fund, as we are now being told, then let's consider if the best way to fund medical research is to levy only the sick : perhaps we should go back to increasing the Medicare Levy so that we all contribute.

It seems that Peter Dutton has failed in explaining himself and the rationale for the $7 co-payment and constantly saying that you cannot expect "free" medical care is just annoying as we all know that we are paying for what has to be one of the best universal healthcare systems in the world.

Rusty:

ScottBE:

13 Aug 2014 6:34:27pm

What makes you think there is rorting Rusty? Do you think people have illnesses for fun? All these doctor visits are by people with Munchausens (a mental disorder which presents with fabricated medical conditions usually requiring surgical intervention)?

Rusty:

13 Aug 2014 6:59:32pm

ScottBE,

What makes you believe that most of these people are actually ill? People present for "illnesses" often because they are lonely and/or bored.

Same kind of people who call Emergency Services (once again free) when a small branch breaks off a tree. Or dial 000 (again free) for a fire engine when their cat goes missing. Or call for an ambulance (again free) because they have a small cut on a finger.

No it is rather a sick attitude that is the problem - that is not a physical illness.

To go to the doctor to the extent that $7 per visit is too high a price means that they must be rorting the system.

Noah's Ark:

13 Aug 2014 10:47:57pm

"What makes you believe that most of these people are actually ill? People present for "illnesses" often because they are lonely and/or bored.

Same kind of people who call Emergency Services (once again free) when a small branch breaks off a tree. Or dial 000 (again free) for a fire engine when their cat goes missing. Or call for an ambulance (again free) because they have a small cut on a finger. "

Guess what Rusty - there are consequences for such actions as you suggest unless of course it may be a very distraught elderly person which can very reasonably excused. I believe the cat scenario can be excused on those grounds.For example in Perth if you call an ambulance no matter who you are you are liable for the $400 call out fee. If you have ambulance insurance then the call has to be for a substantial requirement or emergency other wise you are still liable for the $400 call out fee. It has been in Western Australia like this since the 1990's.

Could you please give me some examples of a small cut on the finger and the cat rescue scenarios Rusty? And of course the outright and dastardly frequency that these events occur. Really Rusty. Beyond the Pale comes to mind.

Noah's Ark:

13 Aug 2014 10:59:19pm

Rusty. "To go to the doctor to the extent that $7 per visit is too high a price means that they must be rorting the system."

Sorry to burst your bubble Rusty but yes it is an expense that many can't afford. Not only the GP but if you require a follow up blood test or Xray then that is also an additional $7.00 for both on top of the GP visit. There are lots of people in Australia on struggle street and many of them are darn fine human beings. Especially when compared to the likes of the wealthy snobbish, bullies who regard nothing in life is more sacrosanct than money, power and profit who in turn justify and rationalise their positions with the various means at their disposal.

There are plenty of struggling families. Struggling with mortgages, energy debts, sickness, injury, fighting for compensation that benefits only the legal profession, family court issues and the list goes on. Not to mention the outright nasty targeting by this government of the elderly, the young, the disadvantaged, the disabled and students. Really Rusty where do you live? I live on planet Earth.

Rusty:

This isn't a discussion about the other costs of living - lets not open up that Pandora's Box.

As well whether people are "nice" or not is irrelevant to the discussion and a total tangent. Aren't "bad" people also entitled to medical treatment? You see the problem with logic on this matter?

This is just about the $7 co-payment that you and others claim the poor can't raise. Just don't believe that individual priorities of expenditure preclude paying for GENUINE and URGENT health care needs. Maybe reduce the amount of takeaway, cigarettes, beer etc. and change priorities to what actually matter most - surely health is the highest priority.

We do look, compared to just about anywhere else, after the so-called poor very well in this country.

NoelP123:

glen:

13 Aug 2014 5:57:16pm

90% of GP visits are a complete waste of time. Take that from me who has to deal with these worried well. Can't say that to the patients though otherwise you end up with a complaint against you. I hear most of the GP's in australia chuckling at this comment as we often do over lunch. Any GP that tells you otherwise ask him how many patients did he/she today and how many problems did he pick up.

I think I think:

13 Aug 2014 6:21:51pm

90%? Got any evidence to back that up. If you truly are a doctor you should know that you will get in far more trouble treating a non existent condition than being straightforward and telling the truth to your patients.

glen:

13 Aug 2014 7:32:53pm

Telling the truth to a patient have you got to be joking. Patient comes in with a cold wants ABs you spend 15 min telling hin that he doesn't need them because it is viral. Said patient goes out to recption makes a complaint see another doctor who writes a script and more superbugs created. Sad state of affairs but most GP visits are a complete waste of time.

glen:

13 Aug 2014 7:28:54pm

Too true. but if I wasn't seeing the worried well I could be seeing more complex cases and taking some of the burden off an overcrowded hospital system. Instead the governemnt makes it financially advantageous to do 5 min worried well visits than 40 min complex care patients.

Noah's Ark:

And you want to save the government all that wasted money currently spent on the worried well.

A person (An ordinary GP) who wants with all his heart to take the burden off the overcrowded hospital system.

To reject the over generous financial advantages of government largesse by doing 5 minute consultations and instead focus on the easily identifiable 40 minute consultations of the complex care scenarios that GP's can access by merely just glancing at someone.

A real person who cares not for himself but for the greater good of society.

splod1:

13 Aug 2014 6:56:40pm

glen: You cite anecdotal evidence to support your perspective, but such evidence is notoriously unreliable. My wife is also a GP, and her experience contradicts yours. Maybe she's been lucky: maybe you've been unlucky, or your patient demographic is different from hers. Too many variables for me to accept your point as true.

ScottBE:

13 Aug 2014 6:31:45pm

Great comment Terry.

Unfortunately this government which promised transparency, accountability and honesty have consistently maintained opacity to their arrangements and information, passing blame onto the former Labor governments and ... well what can one say... a lie is a lie after all.

We won't see any data that would assist us to examine or decide as to the need or potential benefits of a co-payment. They are wedding to the idea of commercial in confidence and so secrecy has become the mainstay of policy development (what a kind euphemism).

And besides... they are right after all (gee my cheek is full of tongue!)

the egg:

13 Aug 2014 6:35:13pm

From the moment Medicare arrived I never really understood the reason why the word Levy was used. Why complicate matters when you can simply calculate what cash needs to be raised and apply a rise to the general rate of income tax. A levy implies that it may be only temporary but it never will be as ill health etc isn't gong to go away any time soon.The Abbott / Hockey nonsense about a medical research fund is exactly that !! Nonsense intended to do a snow job on the public to make it all seem warm and fuzzy.The present complicated half and half system is pretty much a joke as well. I have acquaintance who tells me his recent heart surgery cost $60,000. Apart from the fact that he must have funded , probably 10/12000 of that in gap fees it is likely that if he had NOT had insurance he would have still got the same repair via the public system at virtually no cost to him. It must also be clear by now from the US experience that to leave health entirely to a private system simply does not work either so lets put the political rhetoric and ideology to one side and think how to get good outcomes and value for money invested in health for once.

DannyS:

13 Aug 2014 6:50:25pm

Terry2, Is it really a GP's duty to manage the overuse of the Medicare system? Patient presents, gives information, GP asks a few questions and pokes or prods and decides that there's nothing wrong. Should the GP admonish the patient for wasting their time and our tax dollars?

But maybe, just maybe, there are GP's who will send a patient off with a referral to have this or that scanned, excised or tested. They might be GP's who work in large clinics owned by publicly listed companies that have arrangements with other publicly listed companies such as Pathology laboratories, Medical Imaging companies etc. Just maybe.

It allows the worried patient peace of mind when the test results show no cause for concern, hopefully, and the patient is happy and relieved and forks out a few more dollars for the good news.

It also increases else's bottom line, along with increasing our tax bill.

Alpo:

GRF:

13 Aug 2014 5:24:25pm

"A compromise deal on co-payments will compromise the structure of our health system"?

Well, I'll tell you what will really compromise it; a nation with a net external debt of about 4 trillion and net government sector debt of more than 1/2 trillion facing GFC mark II and an imploding banking sector from a housing crash. Australians are living on borrowed money and borrowed time. Try 'no medicare payments' of any kind and a public sector health system with very constrained finances and that is the most realistic future. And that really IS a big change.

Co-payments? The question is can it save the system? Answer, probably not, but worth a try. Doing nothing is not an option.

I think I think:

GRF:

13 Aug 2014 9:31:48pm

Because the purpose of the co-payment is to reduce perceived over-utilisation of services, not to generate revenue. Which is why they made it revenue neutral by sending the funds to research. Free services tend to get abused. There is also a benefit in changing the mind-set that everything should be free. Ultimately the Australian population will have to be weaned off welfare and the co-payment is like a set of trainer wheels. Get used to it, our current course is unsustainable.

Susan:

14 Aug 2014 11:32:07am

Instead we are sending the money off to 'corporate welfare' - that's right, all those companies who get massive tax breaks for r&d but don't actually produce anything... and now we are going to create a whole new stream of revenue for them to rort. I would rather Joe Blow down the road have my $7 to go to the doctor, than assist some company director with the purchase of the latest BMW to *ahem* conduct company business in!

worrierqueen:

It is a bizarre post isn't it I think I think. Bald statements with no facts or even any logic.

"Can it save the system?"

i didn't realise the system was broken.

"Doing nothing is not an option"

Doing nothing is often the best option. And as has been pointed out since none of the money is going to balance the budget this solution IS doing nothing except to hurt the poor, the favourite activity of tories.

Alpo:

13 Aug 2014 5:25:12pm

This $7 co-payment is purely ideological, that's why the money is not used to feedback into the day-to-day expenses of the Healthcare system, but to pay for medical research (a much longer-term investment). Therefore it must go!

If there is an issue of saving in the broader medical bill for the country, target the Pharmaceutical companies first, and second do as many private health insurance companies do: provide discounts or rebates for activities that improve your health, so that you don't get sick in the first place. But above all, start a campaign to control stressful conditions in the workplace, a true killer of the health of our workers.... But hey, what am I doing, that kind of language is like Mandarin for a Neoliberal politician.

a happy little debunker:

Why should the ordinary punter pay for medical research that will save lives?

I mean, its just so unnecessary, like the PBS & Medicare - that are paid for by the ordinary punter.

If you can't afford health care based on research funded by yourself, then that's your problem - not the governments.

But by far the best way to get a better health outcome is to uncap malpractice lawsuits & deny doctors from access to insurance from their own negligence. If you've got a crook doc - get'em out of health care!

I think I think:

Sir Trent Toogood:

Alpo:

13 Aug 2014 6:34:20pm

ahld,

Medical research must be financed with the taxes from everybody (including Big Business companies), even if we are perfectly healthy. This increases the pool of contributors and decreases the burden on each individual. Charging all sick people $7 per visit to "help finance medical research" is purely and simply an ideological Neoliberal stance based on the concept of user-pay. Please do try to make an effort to see beyond the surface. In this case the user-pay Neoliberal concept is making a bad situation for a poor sick person even worse. Hence it is socially irresponsible, and it must be rejected.

Alphamikefoxtrot:

13 Aug 2014 7:19:43pm

The only irresponsibility is the deliberate attempt to hide the simple fact that health care must be funded somehow. Labor has always refused to accept this reality and just wants to continue its neo-commie tax, spend, lie doctrine that got us into so much trouble in the first place.

Alpo:

13 Aug 2014 8:25:42pm

"Labor has always refused to accept this reality"... Labor funds the health care system (and public education, etc.) with taxes. That's why Labor increases the number of employees at ATO, whereas the Liberals sack them (several hundreds!). If you allow high earners to evade taxes and if you allow them to use too many tax loopholes, you can't complain that you have got nothing in your coffers.... It's elemental, my dear Watson!

Did you write "lie doctrine" referring to Labor?.... Alpha, please keep a bit of grip on reality in the face of the most blatantly, and shamelessly LYING Government in the history of this country! This bunch of Neoliberals have broken all national records in the area of lying.... and not only there.

TrevorN:

14 Aug 2014 4:11:38am

Go back to the beginning: when it started Medicare was financed by a levy (tax) of I think about 3% on everyone. This levy is still in place decades later so the fact is that our health care system is being funded by the taxpayers. The sad fact is that for years governments of both persuasions have been ripping billions of dollars out of the health care taxes to spend on pet projects and on their mates.

Sir Trent Toogood:

a happy little debunker:

13 Aug 2014 9:18:00pm

The trouble with your socialist drivel, is that you expect everyone to pay for the largess received by the few.

Well when I say everyone, you exclude the poor, the sick, the old, the young, the middle aged, the middle incomed, the rich (if they include Rudd & Shorten, but exclude Gina) ... heck you exclude everyone but Gina, but still expect Gina to pay for everyone!

Reinhard:

13 Aug 2014 7:06:59pm

Abbott's changes to the PBS and the $20b Medical Research fund are just like his Direct Action Plan, picking industry winners and then giving them bundles of our cash, little-or-no questions asked. I can just see Abbott's key Pollie Pedal supporters along for the ride too , Amgen, Pfizer, Alphapharm, Roche and pharmaceutical industry group Medicines Australia

Reinhard:

14 Aug 2014 6:08:31pm

By Labor's 'clean energy council' I gather you mean the Clean Energy Finance Corporation that is quite profitable , actually "The CEFC is earning an average return of 7 per cent, which is above the government's cost of funds at 3.5 per cent. Its abolition would result in at least $200 million of lost annual revenue to the government.."Ref: "Clean Energy Finance Corporation faces growing business demand, but its future still in doubt"Tim Flannery's 'hot rocks' project" is "a goer" aka Geodynamics' Habanero 1MWe geothermal plant trial , which concluded in 2013 and by all reliable accounts the trial was a total success

dave:

Jimmy Necktie:

14 Aug 2014 3:29:29pm

good point dave. Now they'll have to open a co-payment office next door to each medicare office. Medicare offices which seem to have no purpose except to refund money (rather than just never collect it in the 1st place).

JessC:

13 Aug 2014 6:48:33pm

"medical research (a much longer-term investment)"

Alpo, you're assuming - and I suppose everyone is - that the medical research fund that the co-payment is paying for is going to be for something useful (like finding a cure for cancer, etc). My fear is that it is going to be used to pay for more of those annoying lightweight lifestyle studies that invariably contradict each other. Y'know, "medical research shows that eating a pineapple a day keeps the doctor away", followed the next week by another study showing that people who eat pineapples have a higher incidence of heart disease or colon cancer.

Koel:

13 Aug 2014 5:27:48pm

A great system ,why change it or make it more complicated?Medicare Levy calculated on income and thresholdsMedicare surcharge for non private insured over a certain income.Medicare seniors and tax offset, reduction and exemption for low income earnersWhy, why, why do we need a surcharge of $7.00?

graazt:

gamesetmatch:

13 Aug 2014 9:23:07pm

Ben, this is going to come as an awful shock to you but governments are instituted among men to guarantee social equity in the market place...perhaps now you might be starting to think on the definition of a social contract!

Smartest Person in the Room.:

13 Aug 2014 7:48:34pm

Well Ben is right and Koel has over simplified the situation. The Medicare Levy and surcharge only bring in about $#10 billion. We spend $130 billion on health services and products. The other $120 billion comes from other taxes, insurance and gap payments.

Ben is wrong though in arguing for a privatised model. Private Health Insurance (PHI) is a scam. Currently it contributes less than $10 billion out of a total spend on Healthcare. It simply subsidies the rich because they are the ones who can afford the gap payments.Studies show it takes no pressure off of the public system as the public system still managed 97% of emergency cases. Out of pocket expense for healthcare are $25 billion, this includes gap payments. After the US we pay the second highest out of pocket expenses in the Western world.

I say get rid of PHI and double the Medicare rebate to cover the $10 billion. Medicare is more efficient.

Koel:

13 Aug 2014 7:30:40pm

For each $7 patient contribution, $5 will be reinvested in the new Medical Research Future Fund. This will come from reducing Medicare Benefits Schedule rebates for these services by $5. $2 will go to the provider.So this legislation effectively gives $2 to a doctor and $5 to a future fund for medical research but removes $7 from the medicare rebate which is the sting in the tail. It is a redirection of funds for medical care. The effect is increase of the medical service by $14.00, $7.00 patient contribution, and $7.00 lost on rebate.

Rusty:

I just do not understand why a $7 per visit co-payment is such a huge impost - even to those on welfare.

Do these people go to the doctor every day! How many people even go once a month?

Many doctors are over servicing and I believe this is possibly a way to, even in a small, way encourage those many thousands of malingering patients in the medical system to reduce the number of visits to perhaps once every 2 days!

Such doctors and their hypochondriasis patients are often co dependents in rorting the system.

As well the plan is after a certain number of visits the $7 per visit cuts out.

dartigen:

13 Aug 2014 6:31:41pm

Some people don't get a choice. If you have diabetes, a heart condition, or high blood pressure, you are supposed to see your doctor every month for check-ups and monitoring. (Most don't, though. It seems a little excessive, but it's not worth gambling with chronic conditions.) And people with autoimmune disorders are in and out of the doctor's office constantly - either struggling to beat down minor infections without the help of antibiotics, or struggling to keep the condition manageable and stay out of hospital.

And then there's kids. Kids get sick, kids have accidents, kids have to be vaccinated. (Adults have to be vaccinated too.) In families, particularly with young children, illness tends to spread fast - usually, once a kid brings a bug home, everyone is down with it a few days later.

(And, of course, workplaces demand sick certificates for any kind of ailment. That I think is where you'll find the major time-wasting is.)

Let's say you have 3 kids and they're all sick. That's $21 already to see a doctor, since they no longer do family consultations.

Or, let's say that you've got a recurrent illness and your doctor decides to do a blood test. $7 for the appointment, $7 for the blood test. Maybe another $7 for a followup. It adds up.

And $7 can be bank-breaking for some people. It all adds up.

It would be better the other way around - 10 free visits and then you get charged. Most people won't use them up, but those with kids might. And it would discourage people from seeing the doctor too often, if that's an actual problem (it's not).

Malcolm:

rusty cairns:

13 Aug 2014 8:31:26pm

But Rusty the "High Frequency" you mention isn't supported by any facts.The belief that work for the dole leads to employment isn't supported by any facts.Planting 20 million trees will sequester 60% of carbon emissions isn't supported by any facts.The belief that FTTN NBN will provide what is will be required in the 21st century and cost less overall isn't supported by any facts. The statement "I'm certain" is used constantly by the Abbott government as a fact, but too often it is not supported by facts. It's just a belief or nothing more than a dream.Where is the treasury forecast of how much the GP co-payment will reduce budget spending ?Please don't be conned by the conmen saying "I'm certain"

Rusty:

rusty cairns:

14 Aug 2014 5:35:15pm

But Rusty the bleating is because many believe the co-payment will cost Australian's more in health spending overall.The bleating is because many see that those with the least amount of money to spare will not go to the GP and have minor health issues cured but end up in hospital with more serious health issues because the minor issues weren't cured. The bleating is because the government is arguing this measure is needed to reduce health cost but doesn't use the money directly to pay health costs.

rusty cairns:

13 Aug 2014 7:24:55pm

GDay RustyAs Dave points out you are wrong to believe there is a cap on the amount paid in GP co-payments.The Australian Medical Association warns the GP co-payment is likely to increase healthcare costs overall. They have given reasons why. Wouldn't an "adult" government consult with health care professionals before announcing a policy about healthcare ?

Rusty:

14 Aug 2014 7:20:32am

correct - the medical profession is afraid that the rorting will stop. If anyone id genuinely ill they will beg/borrow/steal $7 to go to the doctor.

We are not a 3rd world country but rather a 1st world country that has many whingers and whiners who don't appreciate just how good they have it here - and they expect that they are owed everything by the government/people.

Sir Trent Toogood:

rusty cairns:

14 Aug 2014 7:43:39am

GDay Freddie Please can you explain this direct stake you mention ? Ahh Freddie I do believe that $2 of the $7 is kept by the medical practice and it's believed to be way above the cost required to collect and process the co-payment.We still have not be told whom gets the other $5.Would it be a surprise to find out in years to come that family or friends of politicians or doctors started medical research companies not long after the introduction of the GP co-payment ?

Freddie Frog:

14 Aug 2014 8:42:26am

Rusty,The direct stake is that a free system ensures overuse by customers. It's in doctors financial interests to ensure that Tue government throws as much money at health as possible and applies few restrictions.I'd take anything the AMA says on this matter with a truckload of salt.

rusty cairns:

14 Aug 2014 4:51:52pm

GDay again FreddieWho said anything about getting the Healthcare providers to design policy ? Still there is no proof of overuse. Any overuse could be found by monitoring Medicare cards use, and the reason why it is used so frequently investigated.Please read the article above and recognise where health professionals believe the co-payment will cost us more in healthcare overall because minor ailments were not treated at by GP because those effected will not see the GP.This argument seems very valid in my view.The governments argument supported by you is that the co-payment will cure hypochondria and cost the people of Australia less overall but an extra $7 is paid to see a GP.Who's argument relies on a truckload of salt ?When the Whitlam government legislated Medibank it meant that GP's were not paid in cash by the patient the AMA was in uproar.It's cash payments that are the easiest things to avoid paying government duties on.

Susan:

14 Aug 2014 11:34:26am

Clearly Rusty you have not been doing your research. The cuts to medicare apply to EVERYTHING. While $7 might not seem much to you (but it is to many people) - what about $1,000 for some tests? That's right, pay up front, get SOME back from medicare. So now the poor will end up needlessly suffering from ailments that can't be diagnosed properly because they can't afford the testing. Or dying from illnesses that could have been treated if they had been diagnosed earlier.

blax5:

Monty B:

13 Aug 2014 5:36:50pm

I still don`t know what a `price signal` is.

I strongly suspect it refers to slugging people because they are doing something you think costs too much and you wish they did it less. This, combined with bogus data about 11 GP visits per year being the average and its health care USA here we come.

graazt:

We're not just talking about simple consumables though. And you wouldn't keep eating cupcakes anyway (you'd get sick). :)

Health care provision also has element of investment about it. To some extent, it's a wealth enabler, in the same way that other social infrastructure is.

A healthy worker is more productive than a sickly one, by way of one example. They can earn more, and pay more taxes etc...

It's fundamentally an insurance scheme that realises economies of scale to minimise risk in what's an essentially a natural monopoly. Not everyone likes cupcakes. But pretty much everyone likes being healthy.

Yes, there's supply and demand. But "price signals" implies that resources are best targeted to those with the means to pay the price. Rather than those for whom the dollar-spend is most efficacious.

the egg:

13 Aug 2014 7:06:26pm

I'm with you Ben !!!

No taxes at all for people or business. The corollary to this argument would be that we have liveable wages and pay for all the expenses of living from our wage or earnings. Not even a need for government really either. We could all chip in for a local militia to protect us 'cept some would chip in and others wouldn't but hey you get that everywhere.Not sure what you would do with the elderly and infirm but hey that's their problem.I don't know about going back to the '50's with the LNP but we could really get into it and go back to say the 1400's .

Monty B:

14 Aug 2014 8:32:51am

A "price signal" is a way to get the message to the consumer that things are not free...`

Dave, do you personally think things are free? I don`t. That makes two. Do your friends think things are free? I wouldn`t think mine do. Beyond coalition rhetoric is there any hard evidence significant numbers of people think services are free and sitting in a GP waiting room is anyone`s idea of fun?

Primary health (federal funding) keeps people out of hospital (state funding). Shifting the burden is both poor health policy and a false economy,

Susan:

14 Aug 2014 11:37:59am

And attendance at the local emergency ward costs upward of $290. Should the patient be encouraged to go to their local bulk billing clinic (free) or if that is no longer free but the hospital is - what do you think the outcome will be?

Jimmy Necktie:

arf:

13 Aug 2014 5:38:38pm

Adding an additional co-payment adds to the bureaucracy of handling a new revenue stream (This? From 'small govt' LNP?). If you want to make the case that health care needs greater funding, then increase the existing mechanisms.

And stop whining about a massive deficit that Hockey created in the first place.

Morestone:

13 Aug 2014 5:46:44pm

From what the PM and Treasurer have indicated in interviews, the co-payment is intended to be a mechanism for reducing health spending by govt (through less doctors visits due to the "price signal" that the co-payment represents).

Spiralling health costs and the impact on the budget bottom line need to be looked at in a total sense, not by a selective cherry picking process that seems to make very little sense. Looking at meaningful and constructive ways of reducing the rate of increase in health costs (well above CPI over past decade) is something that govts (Labor and LNP) seem to consider too difficult to tackle. It needs to occur and involve a decent dialogue with the community.

Michael:

13 Aug 2014 5:47:58pm

How many doctors bulk bill? If they do it most only bulk bill for pensioners and those who don't work and have health card cards. Medicare is failing and needs major changes a co-payment does nothing and is only playing around on the edges of a failing system.

aussiemandius:

13 Aug 2014 6:15:00pm

Rubbish. I live in a rural area and have access to a multi-purpose clinic which employs 6 or 7 doctors and which bulk bills for all services. When I go there the mix of patients ranges from young kids thru to the elderly, who may or may not be pensioners - I'm certainly not, nor am I unemployed. The doctors there are dreading the co-payment because of the admin nightmare it will cause. They will have to cash on hand therefore they will have to employ security. Their premises are not conducive to cash or card collection and they tell me it will cost them 10's of $1,000's to upgrade.

Malcolm:

tc21:

13 Aug 2014 5:49:03pm

Or just stop government ministers claiming thousands of taxpayer dollars on attending private weddings and football matches, that will save a fortune. If we actually looked at the total MP expenses we would all be shocked. Pensioners should not have to do without to pay for their champagne and cigars.

a_boy:

13 Aug 2014 5:53:30pm

I'm now a pensioner and I have a bad back problem which requires surgery. I have made at least 20 visits to my GP and had about the same to my physiotherapist this calendar year. Naturally there will be more visits in the post-operative period.

How on earth does the government think that a co-payment will be equitable for people like me? The older you get, the more problems arise because of bodily wear and tear.

The number of visits I most probably make this year will be a millstone around our necks and cuts will have to be made to our way of life.

I am by no means an exception and I'm not begging for sympathy because there are many more people with far worse problems.

The Federal Budget is a stinker and need to be renegotiated through the presentation of a mini budget. Abbott , Hockey, Dutton and co have been found wanting. Hockey is the most odious of the lot with his reference to people like me not really owning cars and therefore won't be affected by a rise in fuel excise. Well, perhaps the Medicare co-payment will force me to get rid of my car!

Seriously:

13 Aug 2014 8:44:25pm

Except that the idea is that PPL will:

1) Encourage more women to have children - which will increase demand in the short term (Buying for an extra mouth) and importantly in the longterm as the extra kids mature. Most importantly, a bump in the number of working adults will reduce the burden on future taxpayers - since there will be more of them.

2) By paying women a proportion of their salary, it will reduce the pay gap and allow women to save more in superannuation - which will enable them to be more self sufficient when they retire - and claim less government support.

So - yes - it will cost money in the short term (and I personally think the top amount verges on the high end) but there are sensible policy reasons for it - and you can sensibly argue that it reflects an investment, not a cash giveaway.

Reinhard:

14 Aug 2014 11:12:26am

1:"Encourage more women to have children" You cannot seriously believe that it will lead to such an increase in childbirths that it will ease the burden for future generations?As Smirkin' Pete once said "One for mum, one for dad and one for the country"2 : " it will reduce the pay gap "It may reduce the pay gap between the genders, but without a means test there will be a marked increase in the gap between rich and poor.

"you can sensibly argue that it reflects an investment, not a cash giveaway." An investment you say, Seriously,.......? I can imagine paying rich wives $50K to have babies will boost profits in the areas of fashion, jewellery, cosmetic and cosmetic surgery..

Jimmy Necktie:

14 Aug 2014 3:37:01pm

"as long as they can please their masters"

Why do people have to go and throw in stuff like that? It was a perfectly good argument up till then but now I have to ask how that works in practice - how does one determine who one's master is? Or was it just mindless rhetoric?

Sir Trent Toogood:

Reinhard:

13 Aug 2014 5:54:21pm

Abbott & Hockey are so clueless and egotistical that they still refuse to see, (or admit to seeing) that the voters are onto them. They may continue their denial and bluff and bluster. but the people understand the true aim of the GP co payment is to dismantle Medicare. They also understand their budget unfairly and disproportionately targets low income earners, but they refuse to back down on GP co-payments and cuts to pensions, public health and education. Joe Hockey's comments today on ABC Radio about the relative impact of the fuel excise really show just how desperately out of touch he is. "The people that actually pay the most are higher income people, with an increase in fuel excise and yet, the Labor Party and the Greens are opposing it. They say you've got to have wealthier people or middle-income people pay more. Well, change to the fuel excise does exactly that; the poorest people either don't have cars or actually don't drive very far in many cases."Joe the poor do drive cars mate, that's how they get around, they simply drive more frugally , don't own V8 gas guzzlers and don't own more than one car, unlike most middle and upper income earners.

olive:

13 Aug 2014 6:02:53pm

If we are to fund medical research fund by the means of co-payment, which is expected to end in certain product output - then we are all shareholders of that fund and should be receiving dividends should the profits arise. Saying that - it's wrong to impose the co-payment for such purpose. If there is a co-payment it should go into healthcare system. Saying that - what I really think about it - is to add letter 'n' after the 'co'.

dave:

13 Aug 2014 6:11:19pm

If you want people to decide whether they are really crook enough to spend $7 to see a doctor, well then, ok, it's their choice. But do you really want them to also waste the doctors' time arguing over whether the test, which the doctor thinks is required, is really necessary ? If you want patients to be paying more because of the doctor's opinion, prepare to have that opinion challlenged more often.

ScottBE:

If Medicare needs increased funding we already have the Medicare Levy which can be increased without new legislation.

This proposal makes horrendous complications and will have untenable impacts on the health care of those who need to see their GP more regularly. In effect this would be a tax on the unwell.

It has been said that it is about "sending a price signal". I understand this to mean that the govt considers that many medical appointments are unnecessary! It is not for the government to make this decision. They are not privy to medical consultations and so have no idea as to the necessity of that consultation.

The proposal is ridiculous, misguided, ill-considered and inappropriate.

olive:

Freddie Frog:

I can't believe that expecting people (who can afford it) to pay for a service they use, is somehow seen as an extreme proposal.

The complaints about poor people being affected are problems with our welfare system rather than problems with the co payment proposal.

And the medical research fund was clearly designed to make people believe that the money would go towards health funding when after a few years it was always going to general revenue and fixing the budget deficit.

Victor:

13 Aug 2014 7:33:03pm

So you are another one who has "looked at the research". An armchair expert are we Scott?

I have lived and worked in countries where doctors almost universally commit people .....often children, to hospital at the drop of a hat because they get a premium when someone is in hospital. And there is no doubt that a co-payment as little as $3 is a deterrent from someone finding a 'pain in the neck' or something. Why don't you back up your 'various fora' with some foreplay or something, Scott?

A friend of mine took me to visit her father who had had a stroke and had been in hospital for 2 months.... I happened to run into the neurosurgeon who was treating him and 'had a word' with him.

rabbie:

13 Aug 2014 10:19:33pm

Victor, I have never used Medicare for what you call "recreational purposes". I do not know a single person who has. Can you please explain what you mean and provide real evidence to back up your statement.

Breach of peace:

13 Aug 2014 6:42:34pm

Government is once again conniving and colluding with the medical mafia concerning this latest issue. There is an annual $4,000,000,000 medical fraud and over-serving in 'medicine'! There is another $ 10,000,000,000 approximately in the cronyism of 'medical referrals' to GP's. Any of us should be able to make a simple appointment with a specialist or whoever without the 'referral system' of GP's. Where is the freedom of choice or option to freely choose? Are the politicians simply stupid and devoid of common sense concerning the math or are they pampering to the medical mafia and big pharma once again to get those taxes. There will be enough to go all around without hurting the disadvantaged if you get the doctors out of the pigs trough!

Edward:

14 Aug 2014 8:25:36am

The issue with regard to referrals to specialists is a big one. If you have a confirmed condition that is long term in nature you still have to go to a GP to get a referral. I have a ridiculous situation where I need a referral from a GP to see an ophthalmologist who has to waste time writing a report back to the GP who doesn't read it, or undertake a "follow up" visit (which is an implicit requirement of a "referral" system), or in fact know anything about my condition. `So, I think there's a lot of low hanging savings around beyond simply sending a "price signal".

Davide:

13 Aug 2014 6:50:39pm

This policy was doomed, always. It is just astonishing no individual felt they could voice basic common sense to speak up before it was announced. To tax the sick and dying, to tax children who are sick or need a vacination, is not exactly a vote winner, or reflective of community attitudes. It is just cruel. But more importantly, it shows dumb policy on the run, then making minor tweeks, then no guts to implement it at the slightest whiff of negative media. The effect is to make the party look out of touch, a party plunging from crisis to crisis, not by the hand of an oppossition party, but by some very the Liberal Party's own making. Bill Shorten just has to stay out of the way and he will be the next Prime Minister.

Grumpy:

13 Aug 2014 7:40:30pm

I also fail to understand why the Medicare Levy can't be increased if there is indeed a funding issue. I don't buy the idea that a lot of people are going to their GP for no reason at all - putting up with sitting in a waiting room for an average of 30 to 60 minutes for a 5 minute consultation - give me a break! There aren't that many hypochondriacs or lonely people about. My situation last year was that I had to see my GP every fortnight every 6 months (for prescriptions and for Med. Certs. for my employer) recovering from surgery and returning to work after being misdiagnosed with cancer after having half my left lung removed unnecessarily ....believe me, I wouldn't have been there unless I had to.

observer:

13 Aug 2014 7:53:11pm

The co-payment, is basically another tax so that the money can be made available for a government fund re medical research. The co-payment is nothing but ideology, and will greatly put up the cost of health care for the poor and the sick, and it is the poor who have more ailments. So basically it is a hueg tax on the poor and the sick, but that's ideology. It will be interesting that the co-payment is going to drive another explosion in some other sort of health care which is affordable to by the poor, but will not involve the GP - maybe the we won't need as many GPs. Just as in America health will become unaffordable for a large group of people. The current ideology is that the unions and high wages are the things that cause us to have low productivity, but I would argue that high productivity is based on sound education excellent health services and the right type of investment. This ideology is going to put up the price of health, increase inflation, and act as a tax on discretionary spending, thus putting more people out of work. The whole budget is all about raising taxes. And I would agree with the article the percentage of wealth paid by the poor in taxes is far higher than the percentage paid by the rich. This is also a government who wants to keep wage rises low in the belief that productivity will increase. I think the Governement's logic is well and truly screwed up.

din:

there isn't the money coming into medicare to keep it around in the long term when we look at its costs.

By charging $7, the doctor gets $2 (so that may keep them bulk billing), and the government gets $5.

it also stop people going to the GP for every little thing. Less visits to the GP means they can focus on the sick who do rock up. And less visits means the government doesn't need to pay the GP for that visit which didn't happen.

I like the medicare levy, but that's based on taxable income, and the ABC run a story some time go about how some well off people pay millions to people so they can legally reduce their taxable income to next to nothing. That means they don't pay the levy

by charging a co-payment, they are going to a user pay system - so even the richest person will pay. Plus I believe the payments get capped at maybe 12 visiits a year. Visit the GP more than one a month, and it goes back t being free (for you)

VetTeacher:

13 Aug 2014 9:06:23pm

In all the froth and bubble about the Medicare co-payment what evidence is there that such an impost will actually prevent "unnecessary demands" on the health-care system.

If a person genuinely feels that they(or some-one for whom they are responsible) have a medical problem, reassurance that that is not the case may be as important as treating an actual ailment. Their visit to the doctor is not unnecesary, indeed the cost of treating anxiety and depression from a morbid fear of a self-diagnosed illness may far outweigh the cost of a visit foregone because of increased costs.

To many people $7.50 is simply not a cost high enough to deter them from seeking attention, but the proposal would add co-payments for pathology and other ancillary services. If a GP detects a pattern of patient driven overservicing perhaps they need to consider( and most would do so) a hidden mental condition.

Universal health-care is predicated on the idea that the overall costs of treating illness are usually lower if conditions are detected at an early stage. If the Federal Government trully believes making people decide for themselves whether a visit to the doctor is affordable or necessary a short-term monetary gain may lead to longer term financial commitments.

Oh ,and by the way most commentators (and employers) prefer a community that is characterised by good health. Chronic illness does not do much for productivity or the provision of a well adjusted workforce.

nostradamus:

Pedro 20000:

13 Aug 2014 9:17:24pm

The guy that came up with the co-payment for the LNP said it was done so people will use it less, if it is not totally free. Kind of signs in the mind. People do not appreciate something as much as they should if it is totally free. They will think about it more and use it less. This is actually true.

Nobody:

13 Aug 2014 9:41:53pm

Healthcare today. Education tomorrow. Followed by TPP and the erosion of national sovereignty and democracy in the near future. The question I keep asking myself is: Why do Australians slavishly follow the US inspired corporate state model, a model that failed so spectacularly only 6 years ago? I realise that Australia's a dime-o-crazy (pseudo-democratic corporate state) but that's no excuse - pretty much everywhere is. If you can't bring yourselves to put political pressure on the millionaires, multi-millionaires and billionaires in parliament and their wealthy cronies outside, you may as well just lie down and die.

jarasp:

13 Aug 2014 10:11:53pm

Yes Patrick your comments are spot on about Abbott's lies ..... and Hockey's comments today about poor people not having cars, or if they do, not traveling far. Save us, .........yes.......not a day goes by without a stupid so called policy idea or illogical argument to justify one, by a government minister. Especially regarding the failed budget. What chance does Joe have of being reelected ? Do Ministers just deliver what the spin doctors tell them? There is no sensible plan. These self called grown ups are totally incompetent.

JohnnoH:

13 Aug 2014 10:15:54pm

Please remember that the $7 copayment does not go into helath care. The goverment stripped funds out the CSIRO where health research should be conducted. Hypothetically, the $7 goes into some new research centre, but know this mob who are in charge and they, being totally foreign to the truth, will use the copayments for improve the bottom line of the budget.

ram:

xstephen:

13 Aug 2014 10:47:24pm

I am indifferent to the change. Many Doctors already charge something, bulk billing seems to have shrunk. It seems medical costs just keep going up and I really wonder why. Despite more tests, wouldn't these lead to better treatments and less cost? Why aren't the tests getting cheaper ? Surely with computers/robotics etc prices should be coming down. Or is the medical industry very well versed at extracting money from everyone - we'll all pay just about anything when we are sick. Governments are on a losing wicket when they try to curtail costs. Comparing to other countries is OK if affordability is taken into account - deficits can't jus continue to grow although they seemingly can be ignored for quite a while...

Pert:

13 Aug 2014 10:51:50pm

If the government were really concerned about unnecessary trips to the doctor and cutting the costs associated with Medicare, then they would pass legislation to allow workers to take all of their sick day entitlements without the need for medical certificates.

CheepyGP:

13 Aug 2014 11:43:54pm

I've worked as a GP in a 100% bulk-billing practice since the 1970s and I can't think of any patient who I believed was 'rorting' the system or wasting my time. Nor did the majority of blood tests or radiology tests return completely normal results. On the contrary, I believe that providing good GP primary care and team work saves the acute hospital system billions of dollars by identifying and treating both acute & chronic medical conditions before they require specialist intervention. There are plenty of studies which demonstrate this.

Furthermore, Medicare, like Medibank, was always envisaged as providing a universal health care system which didn't discriminate against the poor, the disadvantaged and the disabled. When every member of a 'community' is treated the same, regardless of socio-economic status, the health outcomes for all groups improve. Again there are studies which demonstrate this. Any attempt to alter this universality further and increase what is already becoming a two-tier system where money can buy better access and treatment should be opposed at all costs. I think you'll find the majority of GPs feel like this. Bulk-billing levels are already high (in the 80% area) and would increase further if the Government GP rebates kept up with the increasing costs of running a practice. This hasn't happened for years.

General Practice provides the least expensive cost per patient of all medical specialties and I fail to understand what the Governments real rationale for imposing any co-payment on GP visits. Saying this is a 'price signal' to 'deter' patients from attending GPs is lunacy. The costs to everyone in dollars and health outcomes will be enormous. Why not increase the Medicare levy or at least do a proper Medicare review led by an independent health economics & epidemiological expert.

Andries:

Piebald Skeptic:

14 Aug 2014 1:41:25am

Twenty years ago, when Medicare covered most things, many of my patients on fixed state superannuation would ask me what medications they could safely cease, because they were faced with the choice of eating, or taking medications. As they did not smoke, and could not afford to drink I had no reason to disbelieve them. I work in areas of poverty, I am now an itinerant rural doctor, but I still see this neglected group. Added to them are the larger group with chronic disabling illness who cannot work, who will face the same choice with a copayment for each service.Duckett is correct, the copayment decision has been made by people with no contact with poverty, and certainly no empathy. It will do nothing to discourage those with high discretionary spending who will continue to attend the vastly over doctored wealthy suburbs of Sydney and Melbourne, and have their psychogenic maladies treated with publicly subsidised medications, and the worried well will continue to be reassured.Meanwhile I will continue to try and manage real health problems without appropriate medications in remote parts of Australia, without being able to ensure that medications are actually taken because there are not enough votes in providing adequate health care to those who live outside the cities and retirement coasts. The copayment decision must either be a demonstration of a complete absence of empathy and understanding for rural and urban poor, or it is a deliberate social engineering policy to kill off the electorally unimportant economic sinks.

Gody A.:

14 Aug 2014 1:54:45am

Joe Hockey was a banker (not an economist) and the only thing a banker is interested in is to generate as much profit as possible, the CBA for instance has made a yearly profit (announced earlier tonight on SBS News) of $ 87 billion. Fine if you're a share holder but not so fine if you are not.

There are more than 110.000 homeless people in Australia, they sleep in the open, even in winter or in cars or doorways. The Hockeys of this world will never be one of them - or will they? In a society health care and an education is paramount even if there is less profit (income) available for the wealthy. For all our sakes. Sack this out of touch Treasurer Hockey and soon.

Piebald Skeptic:

14 Aug 2014 2:10:42am

If you really wish to decrease unnecessary medical visits for 'sick notes'. industrially a 'no fault' leave allocation of 6 weeks for everyone of which 2 weeks can be accrued for up to 3 years. Any leave taken is deducted irrespective of alleged illness. Similarly the time wasting TDR, and sick leave certifications demanded by the Commonwealth.

If this is industrially unacceptable then introduce a fee for service charge for every certificate. If schools require certificate for a student the school should pay, DCS should pay for every certificate they require, employers should pay per work certificate. Currently these unnecessary services are subsidised by Medicare.

Erika:

AWF:

14 Aug 2014 2:37:16am

I've generally been opposed to a Canadian-style Charter of Rights, but this government has changed my mind. Labor needs to go to the next election promising a referendum on a Charter that will entrench the following rights in the Constitution:

1. Free universal health care (and "health care" would be defined so as to exclude matters like elective plastic surgery).2. A welfare system that ensures everyone's basic needs are provided for by the government.3. Affordable housing.4. Public education (maybe even a maximum class size, although that would be hard to define).5. Freedom from arbitrary detention.6. A statement that the rights under the Charter apply to anyone who is under the control of the Commonwealth government, not just people physically present in Australia.7. All government laws and policies to be based solely on empirical evidence.

Erika:

14 Aug 2014 1:54:43pm

I second this!

There are some on the libertarian right who object to the idea of a bill or a charter of rights on the grounds that it limits rights but I think there is a simple fix for that objection: a final clause that states, "The rights in this charter are a minimum, not a maximum and do not preclude any others."

tomtoot:

Alison Cann:

14 Aug 2014 4:04:15am

Stephen,You are attempting to write a thesis about a MISTAKE. To correct that awful mistake is that there should not be a co-payment.SCRAP the CO-PAYMENT.You scrap the copayment and the mistake is rectified.When are you going to see that Stephen?We are not born yesterday like some people who want to bludgeon, kick and kill the poor people of this nation.Should a Million Dollar Tax be put on the rich?it is the same thing.All the poor have got left is their health.All the rich have got left is their money.Go and re-write your article and put a tax on the rich.

JDavid:

14 Aug 2014 4:33:51am

It's interesting that Dr Duckett (an economist) takes the position he does without declaring his affiliations with organizations such as the Fabian Society of Australia. While The Drum is all about opinion and not necessarily about the 'complete truth' but the 'truth as seen by an individual', shouldn't it be a requirement of those privileged with publication of their opinions by the The Drum (our ABC) that they identify their relevant affiliations with organisations that hold influence over a particular world view? Fairness with a socialist perspective does not, in every instance, actually represent fairness ... all one need do is review history.

Helen:

14 Aug 2014 6:08:14am

I am a self funded retiree born with a chronic condition trying to stay in my own home. Now I can have 5 appointments paid for a year on my chronic medical condition care plan. Will I have to pay for them? I always paid my medicare levy. This government is not going to have many elderly voting for them again.

Rob:

KymBo:

14 Aug 2014 7:24:42am

Personally I have not found a Doctor within 20kms of my house that will Bulk Bill for me I already pay on average $60-$90 depending on where I go, $7 won't make any difference to my decision making process which as always has been "is it really bad enough to pay over $100 once I buy the meds" and most times it is no and I battle through and pass my disease around the workplace and the cycle continues.

But I understand the frustrations of those lucky enough to not have out of pocket expenses currently, if I had been able to get a completely bulk billing doctor all these years and then had to start paying I would be upset.

maureen:

14 Aug 2014 7:32:44am

I worry about co-payments and it is not about me as I am a pensioner. But, once you let the cat out of the bag the damage will be done. How long will it take for it to be increased. Every time money is needed for another budget it will hit the co-payment. Politicians cannot help themselves.

Throughlenz:

14 Aug 2014 7:35:38am

Stephens observations are 100% correct. This Liberal Gov "Policy" exemplifies exactly how they administer government (now you take that medicine young boy, it's good for you). Much like many of the "so called GP" comments expressed here (patronizing the public as the "worried well") the parallels between the two are chilling. Unsympathetic, as you would expect if navigating with a "misguided" moral compass.

H P Dietz:

14 Aug 2014 8:35:48am

Stephen Duckett seems to be unaware of overseas experience with co-payments. A 10 E co-payment was dis-established by unanimous vote of the Bundestag in Germany in 2012 because it had become clear that the scheme probably cost as much to administer as it raised. All those billions raised from patients went into nonproductive bureaucratic activity.

People such as 'realist' usually deplore over-regulation. Well, here is your opportunity to resist red tape that will reduce productivity in health, as any GP will be happy to tell you.

But then excessive bureaucracy is so much part of contemporary Australia that most people probably think it's normal.

Peter the Lawyer:

14 Aug 2014 11:28:38am

Excellent reasoning HP Dietz.

The whole Meidcare system is rife with bureaucracy. But the left love it, as they all bureaucrats at heart. If they didn't have cushy public sector jobs they would have to engage in commerce which they abhor so.

The problem here is that a principle needs to be established: people need to value medical services and not expect to get things for nothing.

Septic the Sceptic:

nick:

14 Aug 2014 8:43:31am

the pleasing thing about the co-payment is that we are finally having this discussion . medicare payments to GP has remained stagnant for close to a decade and rather than lobby for greater subsidies or raising their fees to make their argument GP,s have simply reduced the time the see patients and quality of service offered. this is one of the reasons for over servicing 10 six minute poor quality consultations rather than spending the time required leading to poor quality medicine and a significant reduction in satisfaction from patients not to mention a significant erosion of the patients belief in the capabilities of their GP. for those of us that can afford to pay what these service cost we should be expected to do so but we should then also expect a good service. the rise of the bulk billing corporates has had a massive negative impact on Australian health can we please have doctors that show me they are good at what they do not free i dont care if you are free but dont take the time to do your job well. We as a nation are training our population that we can and should be able to walk into any medical service whenever we want and demand a service and that it should be free. The GP need to show some leadership and return to practicing in the best model for patient outcomes not patient wallets and charge what they think they need to not charge nothing then reduce services to match it. this whole 7$ argument is silly it will only amount to 70$ if a few patients do not return because they are charged 7$ the GP needs to suck it up for the benefit of the whole population our system is creating a servcie expectation of poor quality immediate services that are free. currently we have individuals driving to thier doctors in their Mercedes refusing to return unless they are bulk billed then trotting off to the chiro and parting with 500$ then a pop down to the pharmacy natropath for some holly water at another 200$.GP should be at the forfront of preventitive medicine I have not had my blood pressure taken for 5 years no blood sugar tests despite significant risk factors i just want to find a good GP that will offer me a good service regardless of the price my last visit took 120 seconds

Redfella:

14 Aug 2014 8:45:59am

Some services should never have been privatised. The argument that the private sector runs things more efficiently driven by profit is old and tired. Get rid of the private health system, leaving it self funded for those who want to pay for it. Put all govt money into the public sector. The argument that this places too great a pressure on the public service is old and tired too. In the short term yes, but longer term our taxes will provide the services that Australian people want. If govt doesn't they should go. The money funnelled into the private sector's profits is the greater draw on the public sector.Don't start me on education, law enforcement and public utilities...

Peter the Lawyer:

14 Aug 2014 11:21:21am

Redfella

The problem is that the taxes won't cover health and education, and that these are State responsibilities.

The reasons why the tax take isn't enough are many. But principally it is because the Government has expanded into so many other areas where it shouldn't be. The list of grants given by governments to all in sundry is now massive. The social security bill is also massive.

Also heath now costs a lot more than it did 50 years ago, because of scientific advance. 50 years ago people were used to dying at 60. Now we wnat more and better care. We live much longer. Doctors are having to learn more about geriatric care than they did before.

So if we wnat to go back to the age of public health being funded by government, then we really have to stop the government spending on things like the NBN or NDIS, or PPL or the other vast array of middle class welfare.

Redfella:

14 Aug 2014 12:58:44pm

The primary reason why there isn't sufficient government income to cover public health is the moronic belief in the population tax = bad. Perhaps its the dumbing down of political discourse in general.I would argue that your comments regarding technology equalling higher cost is countered by that higher cost coming from health privatisation in the first place. Advances have been driven by private enterprise (predominantly in the US) where profits are protected by the patent system.I agree that middle income welfare removal should tie in with this issue. My point is the govt should get back to basics and manage those areas of the economy where profit should not drive delivery - health, education, law enforcement, utilities

slartiblartfast:

14 Aug 2014 8:48:38am

In my practice we bulk bill about 50% of consultations. There are some situations where asking for a co payment is just not fair or practical. This includes visits to nursing home patients and home visits to patients who have advanced cancer or degenerative illnesses. The government is going to be asking GPs to cop a substantial reduction in the Medicare rebate for providing these sorts of services when already there is a shortage of GPs who are willing to do home consultations and nursing home visits. I also fail to see why GPs are going to be penalised for bulk billing particular patients who they know to be going through tough times with limited financial resources - there is such a thing as compassionate bulk billing.

Having worked in 100% bulk billing practices I am not in favour of that model. My experience was that 100% bulk billing meant that the consultation covered one problem at a time, with any additional problem deferred to an additional consultation which was booked on the way out. When someone has paid for a consultation they will quite rightly demand that all of their presenting problems be dealt with during the one consultation, even if that is not always possible. Without doubt patients have valued my advise more when they have paid something directly for it.

Hopefully the government will come up with a sensible compromise after their discussions with the AMA.

VoterBentleigh:

14 Aug 2014 9:04:49am

Taxpayers are already making a co-payment via the Medicare levy. What the Government proposal will to do is make the sick pay more for their own care, while proportionally reducing the contribution of the healthy and wealthy. No-one chooses to become ill; so to introduce a user-pays system is fundamentally unfair.

smoranean:

14 Aug 2014 9:20:11am

Most likely it will get chucked in the Team Australia bin and forgotten, but not because of a paltry $7 though. It's not the money, it's the principle.

Just because I'm poor, that doesn't mean I'm cheap. On the contrary. Last time a GP actually did his job, treated me like a human rather than some non-sentient being, and signed his blessed name on a prescription sheet, I shook his hand, wished him well, walked out to reception and happily paid $70 odd cash for the almighty paperwork I'd been begging he and a couple of his high-rolling mates for, for over two years.

I was on the dole on July 21st 2009, but I was coming close to dying on average around two nights a week without the required prednisolone to open the lungs up and fight the asthma. That's why I paid cash for his good common sense after he saw the murderous gleam in my eyes and decided that it would be in the best interests of his own vitality to sign the damn script before I knocked his turban off his noggin, poked out both his eyes and wrung his scrawny little neck. You know what they say about desperate times and desperate measures.

Do you think I would have paid the desk clerk 7 cents on my way out if he hadn't done his job?

If everyone is going to be asked to pay for a doctor visit, then guess what? The customer is always right. This could be a great benefit for us all, because these arrogant know-it-alls who are often observed loitering around medical centres between golf games are going to have to cater to a new set of needs of which they are perhaps unfamiliar ...

... someone else's!

Otherwise they won't get paid. That's how it works in real life. If you hire someone to mow your lawn, and they don't do it, you don't pay them. Just the same, if you hire someone to write a 'script, and they don't do it, you don't pay them.

The hubris if the AMA sold down the river for the price of $7. Brilliant stuff Dr Glasson.

Peter the Lawyer:

The bulk billing system just encourages people to go to the doctor on the flimsiet of contexts and encourages doctors to over-service.

People don't value what they don't pay for and have little control of the service they are provided. if you pay for a service then you have more control over that service.

I often wonder what would happen if the Government got out of funding healthcare altogether. WOuld the costs for all those tests that take 5 minutes come down? I suspect that there is a lot of distortion in the health care market because of the subsidies paid by the government.

Peter the Lawyer:

14 Aug 2014 10:53:18am

I get the impression that the writer of this article and many commenters here seem to confuse medicare with the health system. They are two different things. Medicare has nothing to with the provision of healthcare. Medicare is a means of insurance/funding of the proviision of healthcare. However, many people can't seem to tell the difference. The hear the word 'Medicare' and immediately think it means their doctor and the hospital.

This confusion means that people tend to think that if Meidcare is changed or abolished then doctors won't be there and hospitals will close.

The argument here is over how healthcare is funded not over healthcare itself.

Rick:

14 Aug 2014 11:52:10am

A couple of things annoy me about the 'co-payment'.First the argument runs that nothing is for free and nobody should expect to visit the doctor for nothing. Fact: THEY DON'T. Medicare is not free - it is paid for by a levy. It can be argued that the levy doesn't cover the cost. If that is the case we should increase the levy in the same way that private health premiums rise every year.Second is the assertion that medical costs have to be controlled. If that is the case why is the money raised from the proposed co-payment being put to a supposed future research program and not to cover those health costs.All civilised countries ensure health coverage for their citizens. We have a very good system - certainly one which operates at half the cost of the American system which Dutton and his cigar chomping mate would like us to emulate. Once a co-payment comes in it will continually increase and the number of doctor visits required before bulk billing is allowed will continually increase until universal health coverage is no longer available.

toady:

14 Aug 2014 12:52:44pm

No this copayment cannot be sanitised. You can't put lipstick on a pig. We pay our Medicare levy. Why do we need to pay a "user pays tax" on top of the levy? Why wasn't the Medicare levy just increased to cover the shortfall? Why does this government single out the less fortunate? If I'm sick and have to go to a GP I'll be reminded every time of just how mean spirited this government is. There is no way around that. Think about it. EVERY time I go to see a GP . . . .

Greg C:

It is so wrong an idea, this whole user pays idea but especially in health. Who ever chooses to be sick and then chooses to visit the doctor.

The only solution to get more money into health is increase the Medicare levy. Then everyone pays a little for the unfortunates who are sick.

As for stopping the subsidy to private health insurance I am all for it. e.g. I pay $320 per month, or about 10 times my Medicare levy. Imagine if everyones private health payments went into the public system. You wouldn't need all of it but what a health system we would have

Realist:

14 Aug 2014 4:47:28pm

I find the responses to my original post quite fascinating. I live outside Australia where we work with the poor, truly poor. Recently one of our staff discovered she had aggressive cancer and only weeks to live. One month later she doesn't know a lot. The hospital has made four appointments for a biopsy and cancelled them all even though we had paid the $120 required.

The minimum wage here is $17 per day and even though she gets well above the minimum she could in no way afford $120.

She knows the prognosis because we gave up on the hospital and took her to a private doctor. For her at concessional rates it costs $28, much more than a days pay.

She is dying. Her four children will have to learn to survive with no government support, nothing. There is no dole, no medicare, no pension, no child support, no youthstart, no centrelink office.

The more I observe of modern day Australia I am glad I no longer live there. I find the faux outrage on behalf of 'the poor' quite sickening. The wealthiest people in the world masquerading as caring by demanding someone else do something for 'the poor' that they refuse to help themselves.

Your greed and pseudo righteousness is repulsive. The real poor would be stunned if they knew the extent of your largesse. Thankfully few have the resources or opportunity to ever findout. Rave on if it makes you feel better but remember those like our friend live and die without any of the benefits you take for granted while demanding even more.